As someone who has been fortunate to never have experienced a migraine, it can be difficult to understand what makes them so brutal. Migraines are more than just your typical headache. They include extremely-painful throbbing of the head, vomiting, nausea, and sensitivity to light and sound. They can be so severe that they are actually debilitating and can last for hours to days. It can prevent a person from attending work or school. Some people affected by migraines even experience auras before the full onset of the migraine. Auras can include flashes of light, blind spots, tunnel vison, tingling of the limbs, or even hearing sounds. Migraines themselves are difficult to treat and understand because they affect each person differently. In addition, unlike many other diseases and disorders of the brain, migraines come and go. They are not a “constant thing” that can be studied easily.
Vasodilation seems to be the main component behind the pain associated with migraines. Neuropeptides – in particular CGRP (calcitonin gene-related peptide) – are released from nerves and cause vasodilation of blood vessels in the cranium. When these blood vessels dilate, it activates the sensory neurons in that same area. It is the activation of the sensory nerves that cause the severe pain. In the head, the main sensory nerve affected with migraines is the trigeminal nerve, one of the twelve cranial nerves. This nerve has three main branches – the ophthalmic branch, the maxillary branch, and the mandibular branch. The trigeminal ganglion, which houses the cell bodies of the neurons that make up the trigeminal nerve, is the main source of CGRP in the trigeminal system. What is actually causing this release of CGRP and the migraine in the first place remains unknown, however. More research is necessary to help determine the cause so we can figure out the best way to prevent and treat migraines.
How, then, are migraines treated right now? Pharmacologically, drugs can be administered to help prevent migraines and help the migraines subside. Triptans are used to treat migraines already in progress and work by acting on serotonin receptors. The drugs are agonists of the receptor and reduce inflammation and cause vasoconstriction of the blood vessels, as well as reduce release of CGRP. Another type of drug, called gepants, can be used to prevent migraines. These drugs work by being an antagonist of the CGRP receptor. Although these drugs are helpful in treatment of migraines, they sometimes can be extremely expensive, limiting who is able to afford them or willing to pay a great deal for them.
It is important that we continue research and put more emphasis on migraines because they can be so debilitating. 12% of the US population suffers from migraines and the pain, vomiting, and sensitivity that is associated with them. It is more difficult to treat migraines, since they are a come-and-go-type disorder, but that does not mean we should put less into research about them. For some, living a life with severe migraines eliminates their ability to go to school, work, or take care of a family. They are confined to a dark, quiet room in hopes that the pain will go away. For those people, developing a better way to treat migraines – or even prevent them – is not only important, but essential.
Migraines and the Bad Case of Vasodilation
